If you have an abnormal prostate cancer screening the only way to
determine if you have, prostate cancer is through a biopsy. The
decision to proceed with a prostate biopsy should be based primarily on
PSA and DRE results. It should also take into account other factors
including your family history of prostate cancer, race, any prior biopsy
history and other significant health issues youmay have. A prostate
biopsy is best performed under transrectal ultrasound guidance using a
spring-loaded biopsy device coupled to the transrectal probe.
Patients are positioned on their side for this procedure and are
given an enema and an antibiotic. The lubricated ultrasound probe is
inserted into the rectum. The physicians will first us the ultrasound to
find the prostate gland particularly focusing on the size and shape and
whether or not any other abnormalities. The most common abnormalities
are shadows, which might signify the presence of prostate cancer.
However, not all prostate cancers are visible. After the prostate gland
has been anesthetized with an injection of a local anesthetic through a
long fine needle that is passed through the probe, the physician
performs the biopsy. Using the spring-loaded biopsy device attached to
the ultrasound probe, the physician removes several pieces of the
prostate gland. Generally, 10 to 12 pieces or cores are removed (or
more, depending upon the size of the prostate gland and the prior PSA
and biopsy history of the patient). Each core of prostate tissue is
approximately 3/4 inch in length and 1/16 inch in width. The entire
procedure takes 20 to 30 minutes. The removed tissue is taken and will
be examined by a pathologist (a physician who specializes in examining
human tissue to determine whether it is normal or diseased). The
pathologist will be able to confirm if cancer is present in the biopsy
tissue. If cancer is present, the pathologist will also be able to grade
the tumor. The grade indicates the tumor's degree of aggressiveness—how
quickly it is likely to grow and spread.
There transrectal ultrasound guided prostate biopsy is usually well
tolerated. Using local anesthetics helps to minimize the discomfort
associated with the biopsy. There are some side effects that may result
from the biopsy such as, blood in the ejaculate (hematospermia)) and/or
blood in the urine (hematuria) however, it should clear up within a few
days for the urine and a few weeks for the semen. High fever is rare,
occurring in only 1 to 2 percent of patients. The antibiotic is
continued for at least 48 hours after the biopsy procedure
How is prostate cancer diagnosed?
Currently, digital rectal examination (DRE) and prostate specific
antigen (PSA) are used for prostate cancer detection. The American
Urological Association recommends that healthy men over the age of 40
should consider obtaining a baseline prostate cancer screening with a
DRE and PSA test. Evidence from research studies suggest that combining
both tests improves the overall rate of prostate cancer detection. For
more information on the DRE exam, please see the page four of our Prostate Health Playbook.
DRE: The DRE is performed with the man either bending over, lying on his side or with his knees drawn up to his chest on the examining table. The physician inserts a gloved finger into the rectum and examines the prostate gland, noting any abnormalities in size, contour or consistency. DRE is inexpensive, easy to perform and allows the physician to note other abnormalities such as blood in the stool or rectal masses, which may allow for the early detection of rectal or colon cancer. Because the DRE by itself is not an effective way to detect early cancer, it should always be combined with a PSA test.
Prostate Specific Antigen Test (PSA): The PSA test is usually performed in addition to DRE and increases the likelihood of prostate cancer detection. The test measures the level of PSA, a substance produced only by the prostate, in the bloodstream.
The blood test can be done in a clinical laboratory, hospital or physician's office and requires no special preparation on the part of the patient. Ideally, the test should be taken before a DRE is performed or any catheterization or instrumentation of the urinary tract. Furthermore, because ejaculation can transiently elevate the PSA level for 24 to 48 hours, the patient should abstain from sexual activity for two days prior to having a PSA test.
Very little PSA is detected from patients with a healthy prostate, but certain prostatic conditions can cause larger amounts of PSA to leak into the blood. One possible cause of a high PSA level is benign (non-cancerous) enlargement of the prostate, otherwise known as BPH. Inflammation of the prostate, called prostatitis is another common cause of PSA elevation, as is recent ejaculation. Prostate cancer is the most serious possible cause of an elevated PSA level. The frequency of PSA testing remains a matter of some debate.
The American Urological Association (AUA) believes that the decision to screen is one that a man should make with his doctor following a careful discussion of the benefits and risks of screening. In men who wish to be screened, the AUA recommends getting a baseline PSA, along with a physical exam of the prostate known as a digital rectal exam (DRE) at age 40. A disadvantage of infrequent testing is that it limits the ability to detect a rapidly rising PSA levels that can signal aggressive prostate cancer, though this is relatively uncommon for men with such low PSA values. Recently, several refinements have been made in the PSA blood test in attempts to determine more accurately, who has prostate cancer and who has false-positive PSA elevations caused by other conditions like BPH. These refinements include PSA density, PSA velocity, PSA age-specific reference ranges and use of free-to-total PSA ratios. Such refinements may increase the ability to detect cancer and these should be discussed with your physician.
It is important to realize that in most cases an abnormality in either test is not due to cancer but to benign conditions, the most common being BPH or prostatitis.
DRE: The DRE is performed with the man either bending over, lying on his side or with his knees drawn up to his chest on the examining table. The physician inserts a gloved finger into the rectum and examines the prostate gland, noting any abnormalities in size, contour or consistency. DRE is inexpensive, easy to perform and allows the physician to note other abnormalities such as blood in the stool or rectal masses, which may allow for the early detection of rectal or colon cancer. Because the DRE by itself is not an effective way to detect early cancer, it should always be combined with a PSA test.
Prostate Specific Antigen Test (PSA): The PSA test is usually performed in addition to DRE and increases the likelihood of prostate cancer detection. The test measures the level of PSA, a substance produced only by the prostate, in the bloodstream.
The blood test can be done in a clinical laboratory, hospital or physician's office and requires no special preparation on the part of the patient. Ideally, the test should be taken before a DRE is performed or any catheterization or instrumentation of the urinary tract. Furthermore, because ejaculation can transiently elevate the PSA level for 24 to 48 hours, the patient should abstain from sexual activity for two days prior to having a PSA test.
Very little PSA is detected from patients with a healthy prostate, but certain prostatic conditions can cause larger amounts of PSA to leak into the blood. One possible cause of a high PSA level is benign (non-cancerous) enlargement of the prostate, otherwise known as BPH. Inflammation of the prostate, called prostatitis is another common cause of PSA elevation, as is recent ejaculation. Prostate cancer is the most serious possible cause of an elevated PSA level. The frequency of PSA testing remains a matter of some debate.
The American Urological Association (AUA) believes that the decision to screen is one that a man should make with his doctor following a careful discussion of the benefits and risks of screening. In men who wish to be screened, the AUA recommends getting a baseline PSA, along with a physical exam of the prostate known as a digital rectal exam (DRE) at age 40. A disadvantage of infrequent testing is that it limits the ability to detect a rapidly rising PSA levels that can signal aggressive prostate cancer, though this is relatively uncommon for men with such low PSA values. Recently, several refinements have been made in the PSA blood test in attempts to determine more accurately, who has prostate cancer and who has false-positive PSA elevations caused by other conditions like BPH. These refinements include PSA density, PSA velocity, PSA age-specific reference ranges and use of free-to-total PSA ratios. Such refinements may increase the ability to detect cancer and these should be discussed with your physician.
It is important to realize that in most cases an abnormality in either test is not due to cancer but to benign conditions, the most common being BPH or prostatitis.
What are the symptoms of prostate cancer?
What are the symptoms of prostate cancer?
In its early stages, prostate cancer often causes no symptoms. When symptoms do occur, they may include any of the following:
In its early stages, prostate cancer often causes no symptoms. When symptoms do occur, they may include any of the following:
- dull pain in the lower pelvic area;
- frequent urination;
- problems with urination such as the inability, pain, burning, weakened urine flow;
- blood in the urine or semen;
- painful ejaculation;
- general pain in the lower back, hips or upper thighs;
- loss of appetite and/or weight;
- persistent bone pain
What are the causes and risks associated with prostate cancer?
What exactly causes prostate cancer is still unknown; however, the
scientific community is conducting research with the hope of finding the
answer soon. The current theory is there are many factors that can
increase a man’s risk for prostate cancer. The following are some
factors:
The disease predominately affects older men and is rarely found in men younger than 40. Approximately 1 in 35 men will die of prostate cancer with African American’s twice as likely as Caucasian men to die of the disease. According to the American Cancer Society prostate cancer accounts for about 10 percent of cancer-related deaths in men between the ages of 60 and 79 and nearly 25 percent in those over the age of 80.
As men age, their risk of developing prostate cancer increases. If you are a heavy smoker, studies have shown that your risk of prostate cancer may double. The good news is the risks decreases to roughly that of a non-smoker of the same age within 10 years of quitting.
Worldwide, prostate cancer ranks third in cancer incidence and sixth in cancer mortality among men. There is, however, a notable variability in incidence and mortality among world regions. The incidence is low (but rapidly increasing in recent years) in Japan and other Asian countries and intermediate in regions of Central America and Western Africa. The incidence is higher in North America and Northern Europe. However, the higher rates in North America and Northern Europe can be due to the different screening practices, genetic predisposition, diet and environmental factors.
African-Americans are in the highest risk group, with an incidence of more than 200 cases per 100,000 black men. While the incidence in Caucasian and Asian men is slightly more than half that of blacks, African-American men tend to present with more advanced disease and have poorer overall prognosis than Caucasian or Asian men.
Men with a family history of prostate cancer are at an increased risk of developing the disease, the more first-degree relatives the higher a man’s risk of developing the disease. In addition, the age of onset the first-degree relatives was diagnosed can increase a man’s risk of developing the disease. Men with a family history of disease are 2 to 11 times more likely to develop prostate cancer then men without a family history of prostate cancer.
There is also considerable evidence showing a Western lifestyle is associated with increased prostate cancer risk and increased death from prostate cancer. However, which specific lifestyle factor is unknown. Engaging in excessive calorie, dietary fat and refined sugar intake with reduced fruit and vegetable and exercise activity is shown to increase the risk of prostate cancer, though the relationship is not entirely clear. However, of those the most commonly cited dietary risk factor is a high intake of dietary fat, though that relationship is still unclear. Being obese is associated also with an increased risk for death from prostate cancer. Thus, the simplest advice for avoiding death from prostate cancer is to prevent obesity and if you are obese, to lose weight and keep it off.
There is a limited amount of evidence to suggest that the worldwide difference in prostate cancer incidence may be associated with dietary intake of soy proteins in other parts of the world. In Asian countries such as Japan and the Republic of Korea where prostate cancer incidence and mortality are just a fraction of that in North America, soy consumption in the form of tofu, soymilk and miso is up to 90 times higher than that consumed in the United States. In a study of more than 40 nations, researchers found soy, on a per calorie basis, to be the most protective dietary factor. This protective role may be associated with two of soy's components, genistein and daidzein that may act as weak estrogens. Estrogens are female hormones that inhibit prostate cancer growth. Some experts have suggested that the worldwide differences in prostate cancer incidence may also be explained by the high intake of green tea by residents of Asia. However, determining which factors from a complex dietary mix cause prostate cancer is not easy and no clear answers have emerged.
The intake of other certain dietary factors such as lycopene and fish oil may also reduce the risk of developing prostate cancer. Cooked tomatoes are rich sources of lycopene. Lycopenes are antioxidants that may protect cells from becoming cancerous. Several studies have shown that the likelihood of developing prostate cancer is reduced by high intake of lycopene. Researchers found men ingesting two or more servings of tomato sauce per week had a 36 percent reduction in cancer risk compared to those who did not, however again, not all studies have supported this. Fish oils (omega-3 fatty acids) are thought to reduce heart disease due to reducing inflammation. Given the presumed importance of inflammation in causing prostate cancer, it stands to reason that fish oils may prevent prostate cancer. Indeed, some studies have suggested this, though others have failed to find any link with prostate cancer risk.
The correlation of vasectomy and prostate cancer risk remains controversial. Although some studies have suggested that men who have undergone a vasectomy are at an increased risk of developing prostate cancer, many other studies have failed to show such a correlation.
Attention has also focused on vitamin D's effect on the prostate. Epidemiologic evidence shows an inverse relationship between prostate cancer risk and ultraviolet radiation, the primary source for vitamin D production. This observation has led some to suggest that higher rates of prostate cancer in the elderly may be partly due to decreased sun exposure or a decline in the body's ability to make vitamin D with aging. However, several recent studies have found no correlation between vitamin D levels and prostate cancer risk and one even found that men with increased vitamin D had a higher risk of aggressive prostate cancer!
Finally, a word of caution is needed. Based upon very exciting data, the National Institute of Health embarked a large randomized trial of over 30,000 men to test whether vitamin E or selenium would prevent prostate cancer. Unfortunately, the trial was stopped early because there was no evidence either agent alone or in combination prevented prostate cancer. Moreover, there was a suggestion that men who took vitamin E had an increased risk of prostate cancer and men who took selenium had a slightly higher risk of diabetes! This highlights the point that there is no easy substitute for a healthy lifestyle involving eating a balanced diet, avoiding dietary excesses, eating plenty of fruits and vegetables, getting lots of exercise, and most importantly achieving and maintaining a normal body weight.
While there are no exact causes of prostate cancer most doctors agree, if you do things that are heart healthy, you will also keep your prostate healthy. Eating right, exercising, watching your weight and not smoking can improve your health and help them avoid this disease.
- Age
- Smoking
- World Region Location
- Ethnicity – being African American doubles your risk
- Family History
- Dietary
- Vasectomy
- Vitamins
The disease predominately affects older men and is rarely found in men younger than 40. Approximately 1 in 35 men will die of prostate cancer with African American’s twice as likely as Caucasian men to die of the disease. According to the American Cancer Society prostate cancer accounts for about 10 percent of cancer-related deaths in men between the ages of 60 and 79 and nearly 25 percent in those over the age of 80.
As men age, their risk of developing prostate cancer increases. If you are a heavy smoker, studies have shown that your risk of prostate cancer may double. The good news is the risks decreases to roughly that of a non-smoker of the same age within 10 years of quitting.
Worldwide, prostate cancer ranks third in cancer incidence and sixth in cancer mortality among men. There is, however, a notable variability in incidence and mortality among world regions. The incidence is low (but rapidly increasing in recent years) in Japan and other Asian countries and intermediate in regions of Central America and Western Africa. The incidence is higher in North America and Northern Europe. However, the higher rates in North America and Northern Europe can be due to the different screening practices, genetic predisposition, diet and environmental factors.
African-Americans are in the highest risk group, with an incidence of more than 200 cases per 100,000 black men. While the incidence in Caucasian and Asian men is slightly more than half that of blacks, African-American men tend to present with more advanced disease and have poorer overall prognosis than Caucasian or Asian men.
Men with a family history of prostate cancer are at an increased risk of developing the disease, the more first-degree relatives the higher a man’s risk of developing the disease. In addition, the age of onset the first-degree relatives was diagnosed can increase a man’s risk of developing the disease. Men with a family history of disease are 2 to 11 times more likely to develop prostate cancer then men without a family history of prostate cancer.
There is also considerable evidence showing a Western lifestyle is associated with increased prostate cancer risk and increased death from prostate cancer. However, which specific lifestyle factor is unknown. Engaging in excessive calorie, dietary fat and refined sugar intake with reduced fruit and vegetable and exercise activity is shown to increase the risk of prostate cancer, though the relationship is not entirely clear. However, of those the most commonly cited dietary risk factor is a high intake of dietary fat, though that relationship is still unclear. Being obese is associated also with an increased risk for death from prostate cancer. Thus, the simplest advice for avoiding death from prostate cancer is to prevent obesity and if you are obese, to lose weight and keep it off.
There is a limited amount of evidence to suggest that the worldwide difference in prostate cancer incidence may be associated with dietary intake of soy proteins in other parts of the world. In Asian countries such as Japan and the Republic of Korea where prostate cancer incidence and mortality are just a fraction of that in North America, soy consumption in the form of tofu, soymilk and miso is up to 90 times higher than that consumed in the United States. In a study of more than 40 nations, researchers found soy, on a per calorie basis, to be the most protective dietary factor. This protective role may be associated with two of soy's components, genistein and daidzein that may act as weak estrogens. Estrogens are female hormones that inhibit prostate cancer growth. Some experts have suggested that the worldwide differences in prostate cancer incidence may also be explained by the high intake of green tea by residents of Asia. However, determining which factors from a complex dietary mix cause prostate cancer is not easy and no clear answers have emerged.
The intake of other certain dietary factors such as lycopene and fish oil may also reduce the risk of developing prostate cancer. Cooked tomatoes are rich sources of lycopene. Lycopenes are antioxidants that may protect cells from becoming cancerous. Several studies have shown that the likelihood of developing prostate cancer is reduced by high intake of lycopene. Researchers found men ingesting two or more servings of tomato sauce per week had a 36 percent reduction in cancer risk compared to those who did not, however again, not all studies have supported this. Fish oils (omega-3 fatty acids) are thought to reduce heart disease due to reducing inflammation. Given the presumed importance of inflammation in causing prostate cancer, it stands to reason that fish oils may prevent prostate cancer. Indeed, some studies have suggested this, though others have failed to find any link with prostate cancer risk.
The correlation of vasectomy and prostate cancer risk remains controversial. Although some studies have suggested that men who have undergone a vasectomy are at an increased risk of developing prostate cancer, many other studies have failed to show such a correlation.
Attention has also focused on vitamin D's effect on the prostate. Epidemiologic evidence shows an inverse relationship between prostate cancer risk and ultraviolet radiation, the primary source for vitamin D production. This observation has led some to suggest that higher rates of prostate cancer in the elderly may be partly due to decreased sun exposure or a decline in the body's ability to make vitamin D with aging. However, several recent studies have found no correlation between vitamin D levels and prostate cancer risk and one even found that men with increased vitamin D had a higher risk of aggressive prostate cancer!
Finally, a word of caution is needed. Based upon very exciting data, the National Institute of Health embarked a large randomized trial of over 30,000 men to test whether vitamin E or selenium would prevent prostate cancer. Unfortunately, the trial was stopped early because there was no evidence either agent alone or in combination prevented prostate cancer. Moreover, there was a suggestion that men who took vitamin E had an increased risk of prostate cancer and men who took selenium had a slightly higher risk of diabetes! This highlights the point that there is no easy substitute for a healthy lifestyle involving eating a balanced diet, avoiding dietary excesses, eating plenty of fruits and vegetables, getting lots of exercise, and most importantly achieving and maintaining a normal body weight.
While there are no exact causes of prostate cancer most doctors agree, if you do things that are heart healthy, you will also keep your prostate healthy. Eating right, exercising, watching your weight and not smoking can improve your health and help them avoid this disease.
What is the prostate?
The prostate is part of the male reproductive system and is a small,
walnut-sized gland that sits below the bladder and in front of the
rectum. The prostate gland secretes a fluid that makes up part of the
semen.Men should discuss with their physicians about their need to have a prostate cancer screening; which helps maintain proper prostate health. For more information please refer to our prostate cancer screening brochure:
Prostate Cancer
The number of men diagnosed with prostate cancer remains high. However, 5-year relative survival rates have increased dramatically over the years. There also has been at least a 25% reduction in the age-specific prostate cancer mortality rate since the beginning of the PSA era. It is estimated that 99 % of men diagnosed with localized or regional prostate cancer survive at least five years, while only 33% of those with metastases at diagnosis survive 5 years.
For African American men, however the statistics are more dramatic. African American men when diagnosed are more likely to be diagnosed at a later stage and 2.4 times more likely than white men to die of prostate cancer. In addition, if you have a family history the risk is even greater.
Thus, it is still important for men to know the facts abut prostate cancer and have an informed discussion with their doctors about prostate cancer testing. For information on prostate cancer please visit the page for our Know Your Stats About Prostate Cancer® campaign, in partnership with the National Football league.
How are kidney stones treated?
Stone size, the number of stones and their location are perhaps the most important factors in deciding the appropriate treatment for a patient with kidney stones. The composition of a stone, if known, can also affect the choice of treatments. Options for surgical treatment of stones include:
- Shock Wave Lithotripsy (ESWL)
- Ureteroscopy (URS)
- Percutaneous nephrolithotomy (PNL)
- Open Surgery
How can kidney stones be prevented?
Unfortunately kidney stones are a recurrent disease, meaning that if you have one stone you are at risk for another stone event. In general, the lifetime recurrence risk for a stone former is thought to approach 50%. Stone prevention, therefore, is essential. Your doctor or urologist may follow up with several tests to determine which factors e.g., medication or diet should be changed to reduce your recurrence risk.
A good first step for prevention is to drink more liquids and water is the best. If you tend to form stones, you should try to drink enough liquids throughout the day to produce at least two liters of urine in every 24-hour period. People who form calcium stones used to be told to avoid dairy products and other foods with high calcium content. However, recent studies have shown that restricting calcium may actually increase stone risk. High doses of calcium, Vitamin D, or Vitamin C may increase the risk of developing stones, especially in people with a family history of stones. These people need to be careful and should calcium supplementation be needed, calcium citrate is best.
If you are at risk for developing stones, your doctor may perform certain blood and urine tests to determine which factors can best be altered to reduce the risk. Some people can decrease their risk with dietary changes while others will need medicines to prevent stones from forming.
Other general recommendations for stone formers is that they consume a low sodium and low animal protein diet.
Do not be surprised, if you are asked to collect urine for 24 hours after a stone has passed or been removed to measure volume and levels of acidity, calcium, sodium, uric acid, oxalate, citrate and creatinine. This information will be used to determine the cause of the stone. A follow-up 24-hour analysis may be used to find out the effectiveness of treatment.
How are kidney stones diagnosed?
Sometimes "silent" stones, those that cause no symptoms are found on X-rays taken during a general health examination. These stones would likely pass unnoticed. If they are large, then treatment should be offered. More often, kidney stones are found on an X-ray or sonogram taken on someone who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the stone's size and location. Blood and urine tests also help detect any abnormal substance that might promote stone formation.
If your doctor suspects a stone but is unable to make a diagnosis from a simple X-ray, he or she may scan the urinary system with computed tomography (CT). CT is an imaging technique that is the gold standard for stone diagnosis as it is an extremely accurate diagnostic tool that can detect almost all types of kidney stones painlessly. Historically intravenous pyelorgram (IVP) was used but this requires prep as well as intravenous contrast dye and serial X-rays.
The abovementioned tests give your doctor information about the size, location and number of stones that are causing the symptoms. This allows the urologist to determine appropriate treatments.
What are the symptoms of a kidney stone?
Once stones form in the urinary tract, they often grow with time and may change location within the kidney. Some stones may be washed out of the kidney by urine flow and end up trapped within the ureter or pass completely out of the urinary tract. Stones usually begin causing symptoms when they block the outflow of the urine from the kidney leading to the bladder because it causes the kidney to stretch.
Usually, the symptoms are extreme pain that has been described as being worse than child labor pains. The pain often begins suddenly as the stone moves in the urinary tract, causing irritation and blockage. Typically, a person feels a sharp, cramping pain in the back and in the side of the area of the kidney or in the lower abdomen, which may spread to the groin.
Sometimes a person will complain of blood in the urine, nausea and/or vomiting. Occasionally stones do not produce any symptoms. But while they may be "silent," they can be growing, causing irreversible damage to kidney function. More commonly, however, if a stone is not large enough to prompt major symptoms, it still can trigger a dull ache that is often confused with muscle or intestinal pain.
If the stone is too large to pass easily, pain continues as the muscles in the wall of the tiny ureter try to squeeze the stone along into the bladder. One may feel the need to urinate more often or feel a burning sensation during urination. In a man, pain may move down to the tip of the penis. If the stone is close to the lower end of the ureter at the opening into the bladder, a person will frequently feel like they have not fully completed urination.
Stones as small as 2 mm. have caused many symptoms while those as large as a pea have quietly passed. If fever or chills accompany any of these symptoms, then there may be an infection. You should contact your urologist immediately.
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